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Dispensed: A big week for digital health IPOs, what happens when a $2.1 million drug can’t get to the kids who need it, and what a top health-tech VC is looking to invest in

Dispensed: A big week for digital health IPOs, what happens when a $2.1 million drug can’t get to the kids who need it, and what a top health-tech VC is looking to invest in

Jackson Schultheis was born with the progressive muscle disease spinal muscular atrophy.

Jackson Schultheis was born with the progressive muscle disease spinal muscular atrophy.
Elissa Schultheis


Welcome to Dispensed, Business Insider’s weekly newsletter bringing you all the stories that kept our healthcare team busy this week.

While Erin Brodwin’s been out celebrating her wedding, the rest of us have been staying busy holding down the fort! Congrats, Erin!!

Are you new to our newsletter? You can sign up for Dispensed here.

First up: Some really important reporting from Emma Court, who spoke with families who are having a hard time getting access to Zolgensma, the $2.1 million treatment for spinal muscular atrophy that was approved in May.

‘Like we were being forced to gamble with our son’s life’: Health insurers won’t pay for a $2.1 million drug for kids, and parents say they’re running out of time

  • A new type of therapy that treats a devastating inherited disease at the genetic level was recently approved in the US. Its $2.1 million price tag makes the drug, Zolgensma, the most expensive in the world.
  • Four parents of children born with the disease, called spinal muscular atrophy, told Business Insider they have been fighting health insurers like Aetna and Anthem to get access to Zolgensma. One decision, by UnitedHealth, has since been reversed.
  • Sarah Stanger, whose son lives with spinal muscular atrophy, called it “heartbreaking, because this one person is everything to us. And they’re acting like his life doesn’t really matter.”
  • These kinds of barriers could create “further inequities in the healthcare system for people with genetic diseases and disabling conditions,” Stanford ethicist Holly Tabor said.

Emma’s reporting highlights an important tension that’s playing out right now – between health plans who are setting up policies that constrain who might be considered for treatment and drug companies that set the $2.1 million price tag – that leave patients and their families caught in the middle. One of the plans in question that came up in Emma’s reporting said it doesn’t cover any gene therapies.

As more and more gene therapies get to approval, tensions are only going to get higher.

A wave of digital health IPOs

Livongo executives Glen Tullman, Zane Burke, and Jennifer Schneider on the day of the company's IPO.

Livongo executives Glen Tullman, Zane Burke, and Jennifer Schneider on the day of the company’s IPO.
Courtesy NASDAQ

Thursday was a big day for digital health companies.

Diabetes tech company Livongo started trading, closing up 36% after pricing Wednesday at $28. Health Catalyst, which helps hospitals sift through their data, also closed out the day 51% higher than its $26 a share price set the night before.

We were tracking the IPOs closely.

Elsewhere, Bright Health on Wednesday laid out where the health insurer will be offering plans starting in 2020. By then, it’ll be in 12 states, which we decided warranted a map (big thanks to Shayanne Gal for that!).

Bright Health 2020 expansion locations map

Shayanne Gal/Business Insider

$950 million insurer Bright Health is plotting a massive expansion as startups look to reinvent how Americans get healthcare

  • The Minneapolis-based health-insurance startup Bright Health plans to double its geographic footprint in 2020.
  • By 2020, the company expects to be in 12 states, up from six in 2019.
  • Bright offers insurance to individuals under the Affordable Care Act and coverage to seniors in Medicare Advantage, partnering with one health system in each market to help set up its insurance plan.
  • The venture-backed health insurers Oscar Health and Devoted Health are also planning to expand in 2020.

With new data coming out on the future of HIV treatment, Emma reports that three companies in particular stand to be the biggest winners. That’s in part because of new treatments, as well as more use of existing, preventive treatments.

The future of HIV treatments will change dramatically in the next decade, Citi says. These 3 companies could be the biggest winners.

  • Since 2012, a preventive HIV medication has been available in the US, making it possible for those at risk to reduce their chances of contracting the disease.
  • Citi analysts predict the US market for these types of drugs will nearly triple by 2030 to about $5.5 billion, thanks to factors like President Donald Trump’s new plan to stop HIV.
  • New drugs from the US drug giant Merck, the HIV-focused drugmaker ViiV Healthcare, and the biopharma Gilead could dominate the preventive HIV market over the next decade, the Citi team said.

This week in conversation with the healthcare team

That’s all from us this week. We’ll be back in August with some more big projects ahead you won’t want to miss.

In the mean time, tips? Plans to file your S-1 for your upcoming IPO (I really do want to know!)? Find me at lramsey@businessinsider or the whole team at healthcare@businessinsider.com.

– Lydia

It’s your health, not your age, that matters when scuba diving

It’s your health, not your age, that matters when scuba diving

When it comes to scuba diving, it doesn’t really matter how old you are but how healthy and fit you are.

“There is no age limit for scuba diving. Studies have shown a person’s physiological age (how well or poorly the body is functioning), not chronological age is an important factor in determining if a person is fit to learn scuba diving,” says Universiti Malaya Medical Centre’s Sports Medicine (UMMC) head of department Associate Prof Dr Mohd Nahar Azmi Mohamed.

Dr Mohd Nahar says that because scuba diving can be a challenging activity and a “gear-intensive” sport , seniors must ensure they are physical fit before attempting to scuba dive.

“Divers over 45 must obtain medical clearance before signing up for scuba lessons. Seniors must have a good fitness level score in cardiovascular, respiratory, musculoskeletal and other fitness tests.”

Conditions such as cardiovascular disease and diabetes are among other concerns that could cause complications during diving.

“Swimming is considered an aerobic form of exercise. And, carrying the weight of diving equipment will cause an increased resistance to their movement. This can make it a physically demanding activity, especially for seniors,” he shares.

Ensure you are medically fit before attempting to learn scuba diving. Photo: Lai Voon Loong

He also advises seniors to adhere to diving safety instructions when on a dive.

“It is important that they carry safety equipment like a marine whistle, signaling mirror and safety light. Don’t forget to take a break after several days of continuous, multiple dives per day. Muscle weakness and joint stiffness are among the problems among senior citizens. Eye sight problems, and poor balance may also contribute to an increased risk of injury among people of this age group.”

n the last 10 years, there has been a continued growth of Malaysians, including seniors citizens, getting their diving certification, says Professional Association of Diving Instructors (PADI) regional manager (Malaysia, Singapore and Brunei) Neil Davidson.

Also read: These seniors prove that you’re never too old to dive

Seniors are advised to adhere to diving safety instructions when on a dive. Photo: Tourism Malaysia

Many of the country’s seniors dive instructors, he says, are those who obtained their accreditation over the years.

“Over time, they have become senior citizens while still being active diving instructors. Malaysia is lucky to have a great depth of experienced PADI members who are still keen to create new divers whatever their age. You are never too old to enjoy the amazing marine life that Malaysia has to offer. It can become addictive and a great way to bring you closer to nature and can also become a family activity,” he says.

As a safety measure, Davidson explained, all divers must complete the Recreational Scuba Training Council (RSTC) Medical form with information about their medical history, if any.

“If there are any medical concerns, they must be signed off by a diving physician. The form does also include an extra section for people aged over 45,” he says.

These seniors prove that you’re never too old to dive

These seniors prove that you’re never too old to dive

Scuba diving may seem to many as an activity more suited to youngsters but 65-year-old dive instructor Christy Ooi believes that one is never to old to take the plunge. In fact, the sun-kissed and adventure-loving senior believes that scuba diving is a “gentle sport” that’s perfect for seniors who want to keep active without the risk of injury to their joints.

“Each dive lasts for about 45 minutes and divers swim at a leisurely pace. Diving is a low-impact exercise that’s suited to seniors. The only difference is that you are underwater,” he says.

Ooi has been a scuba diving instructor for over three decades and doesn’t plan on hanging up his fins and putting away his wetsuit anytime soon.

“I’ve been diving for 30 years and I’ve lost track of the number of dives I’ve been on. Once you learn how to dive, you never want to leave the water. I’ll continue to dive as long as I can,” says Ooi passionately.

Becoming a dive instructor wasn’t something Ooi dreamed about as a youngster. After this secondary education, he studied drafting and worked for 15 years as a draughtsman in an architectural firm. But he grew bored with his office-bound job. He wanted a change.

Loo (left) and Ooi are fine examples of scuba diving instructors in their 60s.

By then, Ooi had already obtained his scuba diving certification. It was the 1980s and scuba diving was deemed as an expensive hobby for the “elite”.

The water sport was perceived as being a sport for the extremely adventurous, those who liked taking risks. Ooi reckons that he was one of the first few Malaysians to learn scuba diving here.

“I was bored with my mundane and routine job that had me sitting in the office for 15 years. I was looking for some adventure in life. So, with my diving instructor’s certificate, I decided to take a leap of faith … to dive into uncharted waters,” he shares.

The jovial father-of-one went on to obtain his Professional Association of Diving Instructors (PADI) certification in 1990 and became a dive instructor. Ooi has absolutely no regrets about leaving his career as a draghtsman.

“Life is all about choices. Though my career switch may have seemed unconventional years ago, I am happier. As a dive instructor, I can dictate my own working hours and lead a less stressful life. Plus, I get to be a beach bum and soak in the sun and have some fun,” jokes Ooi.

It was Ooi’s love for the outdoors that fueled his passion for scuba diving.

“I grew up before the Internet era. As a child, I spent a lot of time outdoors, catching tadpoles in streams and fishing with friends. So, I suppose I signed up for scuba diving because I wanted to reconnect with nature, specifically the underwater world,” explains Ooi who takes his students to the east coast for their dives.

Senior citizens make up a sizeable part of the diving community, partly because divers who started out in the first flush of its popularity 30 to 40 years ago have now aged. – Filepic

According to the Divers Alert Network (DAN), an American non-profit scuba diving and dive safety association, older divers (those over 50 years old) now constitute an increasingly large percentage of the global dive community.

“Two main factors are responsible: divers who took up scuba in the first flush of its popularity 30 to 40 years ago have aged, and second, today’s older generation is typically wealthier and more active than ever before, and is adopting diving as the pastime of their golden years,” says DAN in their webpage.

Once he started diving, there was no turning back for Ooi. Photo: Christy Ooi

According to the association, seniors who started diving in their youth are likely to be safer in the water than many younger divers, because of their experience: they’d be able to deal with a range of problems and scenarios that younger divers may be unfamiliar with.

Still, Ooi advises fellow seniors who want to scuba dive to make sure they are medically and physically fit.

“I have students who are in their 70s and they have never experienced any issues learning how to dive. However, I would advise the elderly to undergo regular health check-ups before signing up for a scuba diving course,” advises Ooi.

As a dive instructor, Ooi too needs to keep himself in shape, not only physically but also mentally.

“I keep up to date by reading articles on diving websites, especially articles on water safety,” says Ooi, who is trained to administer emergency first aid, and is also a rescue diver and divemaster.

Scuba diving also provides seniors citizens with an avenue to socialise, he says.

“Scuba diving is the best way to meet and interact with like-minded people. After each trip, divers always make it a point to gather for food and drinks. Everyone is happy to share their dive stories and adventures and also divulge tips.”

Over the years, Ooi has forged good friendships with many fellow divers. One of them is dive instructor Loo Kit Choong, 63. The two have known each other for four years and have gone on several diving trips together in Malaysia and Indonesia.

Also read: It’s your health, not your age, that matters when scuba diving

Scuba diving allows Loo an opportunity to bond with his sons, Shen Quang left and Jey Quang

Loo considers himself to be a late bloomer when in comes to scuba diving, having taken up the sport only after turning 50. He was inspired to learn to dive after meeting a group of divers in Redang Island, Terengganu.

“Those guys looked so cool in their wetsuits, and it seemed like they were having so much fun in the sea. I decided to follow in their footsteps,” says Loo, a retired sales manager.

Loo was hooked on first dive and has never looked back since.

“Every island has it own beauty and nothing compares to being in pristine waters and appreciating the rich diversity of marine life. I especially love untouched islands like Indonesia’s Raja Ampat Island and Komodo Island, and Sabah’s Pom Pom Island and Mabul Island. Diving is very addictive. One you start, it’s hard to stop,” says Loo, who earned his PADI instructors certification when he was 57.

He too thinks that age shouldn’t be a hindrance to picking up scuba diving.

“Scuba diving is like any other sport. The only difference is it’s underwater and one needs to be able to swim and be confident in the water,” he says.

“Everyone is always happy to share stories of their dive, adventures and diving tips,” says Ooi (right).

Loo has been a part-time diving instructor since 2007. The job, he says, keeps him busy and allows him to earn “extra pocket money”.

“I enjoy organising dive trips, and working with different tour operators on the different islands in the east coast, Sabah and Indonesia. But the best bit is meeting people from all walks of life, especially those who love the outdoors. Plus, I love teaching people not just about diving but also conservation.”

On each of his dive trips, Loo makes it a point to do sea and beach clean ups.

“I can’t stand seeing thrash strewn in the ocean. Besides, it’s our diving playground and so we must try to keep it pristine for the others to enjoy,” says Loo.

As much as he loves diving, Loo confesses that best trips are the ones he goes on with his sons, Loo Shen Quang, 33 and Loo Jey Quang, 27.

“My sons have busy work schedules and hardly have any free time. During these trips, we get to relax and enjoy each other’s company. We get to strengthen the family bond too.”

Loo reckons that more seniors should “step outside the confines of homes”, reconnect with nature and get active.

“People are too caught up with social media. Rather than be in the virtual world, explore the outdoors. Reconnect with nature through activities like hiking and swimming. It’s a great form of exercise to keep healthy.”

Level up your nutrition

Level up your nutrition

In a world that is progressively becoming more sophisticated and complex, dealing with stress and living up to daily expectations also increases.

Multitasking is fast becoming a common occurrence as most urbanites work long hours.

And when they go home, they have to attend to their children or end up wrapped up with various electronic devices. So instead of having a good rest like sleeping, they risk spreading themselves too thinly. Before long, fatigue creeps in and affects their already hectic lifestyle.

Also, to save time, most city dwellers end up eating out instead of cooking at home. Unfortunately, food prepared commercially usually prioritises taste over nutrition, which means most city folks may not be getting the right nutrients to support their way of life.

Another factor is the choice of food we Malaysians love to eat.

Using a secondary data based on the Malaysian Adults Nutrition Survey (MANS) 2003 and MANS 2014, the Institute for Public Health, Kuala Lumpur, noted that Malaysian adults consume a wide variety of food items daily and weekly. (1)

A majority of that includes rice. which is eaten twice a day with an average intake of 2.5 plates per day, and many preferred sugary foods and beverages as sugar was the second most common choice of food consumed on a daily basis.

It then pointed out that more efforts should be undertaken to instil healthier food choices and dietary practices among Malaysians.

One way to supplement the lack of nutrients in the daily diet of sugary drinks and white rice is to take multivitamins.

This practice is quite common in countries like the United States where adults there widely take multivitamins, hence a study was carried out by Jeffrey B. Blumberg et al, published February last year to assess the health benefits and risks of multivitamins and other dietary supplements. (2)

They found that multivitamins have been shown to reduce the prevalence of inadequate micronutrient intake, especially if it is below the estimated average requirement intakes.


Better nutrition provides for better energy levels.

Pharmaton is marketed as a product that helps to maintain energy levels. It is a dietary supplement that contains compounds to help alleviate fatigue.

Its capsules contain three carefully balanced groups of active ingredients: concentrated, standardised ginseng extract; vitamins, minerals, trace elements that assist in metabolism; and lecithin.

The vitamins in Pharmaton capsules include vitamin D, calcium, iron, magnesium, vitamins A and E, and the B vitamins riboflavin, folic acid, thiamine, vitamin B-6 and vitamin B-12 to alleviate metabolic processes (www.livestrong.com/article/288399-what-is-pharmaton).

The added ginseng extract G115 helps increase energy levels. There was a double-blind study done on the multivitamins Pharmaton capsules in 1996 by A. Caso Marasco et al of the National Autonomous University of Mexico (Universidad Nacional Autónoma Mexico) to compare the quality-of-life parameters in subjects receiving multivitamins plus ginseng with those found in subjects receiving multivitamins alone. (3)

The study involved 625 patients, both males and females who are split into two groups and are given a capsule per day for 12 weeks.

The study results showed that adding ginseng root extract to a multivitamin base produces a better dietary supplement.

For more on Pharmaton, visit its website here.

KKLIU: 1487/2019
SASGM.PHAR4.19.07.0295 (07/19)

1) Noraida Binti Mohamad Kasim, Mohamad Hasnan Bin Ahmad, Azli Bin Baharudin @ Shaharudin, Balkish Mahadir Naidu, Chan Ying Ying & Hj Tahir Bin Aris. “Food choices among Malaysian adults: Findings from Malaysian Adults Nutrition Survey (MANS) 2003 and MANS 2014.” Malaysian Journal of Nutrition, Vol. 2, No. 1, March 2018. pg 67-75.

2) Blumberg, Jeffrey B et al. “The Evolving Role of Multivitamin/Multimineral Supplement Use among Adults in the Age of Personalized Nutrition.” Nutrients vol. 10,2 248. 22 Feb. 2018, doi:10.3390/nu10020248

3) Caso Marasco, A & Vargas Ruiz, R & Salas Villagomez, A & Infante, Claudia. (1996). “Double-blind study of a multivitamin complex supplemented with Ginseng extract.” Drugs under experimental and clinical research. 22. 323-9.

This is a supplement product advertisement.

When should you start giving your child pocket money?

When should you start giving your child pocket money?

How do you determine when your child should get an allowance and what the amount should be?

Having allowances is an opportunity for kids to learn about financial responsibility and money management. It is a great way to teach them to be independent, patient, charitable and appreciative.

Allocating allowances for kids is a significant step in their process of growing up.

Money matters

As a guide, give your child RM1 per age every week i.e. a 10-year-old will get RM10 per week, though this depends on your financial situation and the standard rate in the area.

The idea is to increase the amount appropriately as they grow up, according to their needs. This amount should cover more than the basics (e.g. lunch and bus fare) so they can save the extras. Hence, it is important to discuss how you expect your kid to spend the money.

You can start giving them allowances as early as preschool or primary school, to spend at the canteen or the stationery shop.

Starting from young is important, as letting them handle cash will teach them to distinguish the value of different bills and coins. Dealing with transactions also helps them enhance their mathematical ability.

There are different approaches to allotting allowances. It can be given on a regular basis, depending on your preference.

You can start giving allowances daily when they are young, and switch to weekly or monthly as they grow older and learn to handle larger amounts of money. Getting a regular allowance makes it easier for them to plan their budget.

To earn additional allowance, get children to go odd jobs that are suitable for their age.

Allowances can also be given based on needs. Your kids will have to ask you whenever they run out of money. Discuss their request and teach them about the differences between wants and needs, as well as appropriate budget strategies.

If they want to buy something that costs more than their allocated budget, they have to save up and put aside immediate wants, thereby teaching them self-control.

Learn to earn

When talking about chores and allowances, one opinion states that kids have to earn their allowances by doing chores, and another says kids are expected to be responsible for chores without being paid.

Linking chores to allowances can teach them that they need to work to get what they want, but they may ditch the chores if there are no consequences other than not getting the allowance.

On the other hand, separating chores and allowances can teach them to be responsible as a family member, but they may take the allowance for granted if they do not have to work for it.

As a solution, separate regular allowances and chores (e.g. throwing out trash, washing the dishes, etc.), and offer to pay them extra for doing additional chores that are bigger and tougher (e.g. washing the car), as long as the chores are suitable for their age.

After all, doing household chores teaches them life skills and to be responsible without expecting rewards.

Doing household chores teaches children life skills and responsibility.

Here are some handy tips:

  • Help them budget. Teach them to allocate how much they are going to spend for immediate purchases and how much to set aside for savings.
  • Let them spend, but set a limit. Do not micro-manage how they spend their allowances, but step in if it breaks your rule, e.g. spending all their money on junk food.
  • Be firm with the allowance schedule. If they ask for an advance because their funds ran out, do not simply bail them out.
  • Don’t punish them by cutting allowances. If they misbehave, take away their privileges instead, such as limiting television time or Internet access.
  • Practise what you preach. Your financial habit will influence your kids. If you usually overspend on unnecessary things, they will think that it is an acceptable behaviour.

Different parents may have different preferences of giving allowances.

But one thing is certain – financial education should start from young, and letting kids manage their own money is a good way to start.

Alexius Cheang is a behavioural psychologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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